CAMHS Roundtable – The Dog Shit in the Room

I sometimes get scared before meetings, especially BIG MEETINGS, with LOTS OF PEOPLE, lots of PROFESSIONAL PEOPLE. And so it was before the CAMHS ’round table’ meeting hosted by DfE yesterday.

There was an anxiety dream. I was late for the meeting. I couldn’t find the room it was being held in. I searched and searched. I found it. I walked in. The only available chair was across an enormous room, packed with people. PROFESSIONAL PEOPLE.

As I made my way across the room, all eyes on me, I smelt a terrible smell. A stink. I looked down at my shoe. I had trodden in an enormous dog shit. It was clinging to my shoe in all it’s marvellous turdyness. There was outrage. Who is this woman dragging in this dog shit?

As Al writes in his blog, we both asked families about how CAMHS could better suit the needs of adopted young people (it was recognised that some vulnerable groups of children and young people, and CAMHS, are not a ‘good fit’). We were both deluged with responses. And I mean DELUGED. We spent hours engaging, collecting and collating the response.

We rather nervously presented our work – your work – to thirty people from the fields of mental health, commissioning, research, social care, the voluntary sector and policy making.

We delivered some difficult messages. We were treated with nothing but respect and what we presented was widely recognised and accepted. We listened and engaged, because this is a complex area and all of us have a lot to learn from each other.

What Al and I presented would have been nothing without all the help and input we received. Thank you to every single person who took the time to provide experiences, thoughts and ideas.

There are some huge mountains to climb in order to achieve a CAMHS which better meets the needs of all children who have adverse early life experiences, whatever their legal status. This was the first step. And I’m pleased to report that there was absolutely no sign of dog shit.

The document below is the one I read from at the meeting. A copy has been given to DfE.

CAMHS Round Table – Feedback from Adopters

INTRODUCTION

This is a summary of information gathered informally through engagement with adopters, and some social workers and therapists on social media, private forums and in face-to-face meetings.

ACCESS TO CAMHS

A presumption of need, rather than the burden of proof falling on families

Less restrictive referral criteria

Lower and more consistent thresholds to allow for early intervention

More willingness to address the needs of a child/YP who is ‘refusing to engage’

ASSESSMENT AND DIAGNOSIS

Better-educated and experienced workforce in the broad range of issues around the impact of adverse early life experiences, and in the differences between adoptive and foster families.

Less rigid diagnosis – a strong feeling that children are being forced into narrow definitions. Concern about over-diagnosis of conditions such as ASD and ADHD.

A more ‘multi-faceted’, broad approach that does not ‘silo’ too early on. Families reported having to pass through each silo in serial and some had ‘timed out’ of services by the time this had concluded.

Important that assessments include genetic and other health considerations such as FASD – ‘it’s not always attachment’.

Better appreciation that some parents may present poorly as a result of having lived in crisis for some time.

More serious MH diagnoses for under 18s are not given therefore no treatment offered to young people.

TREATMENT DELIVERY

Appropriate therapeutic parenting courses from an early stage and an end to ‘one size fits all’ behaviourally-based courses.

Access to therapeutic parenting coaching.

Behavioural interventions were reported to be problematic and unhelpful.

Parents keen to be seen as ‘co-therapists’ and given the tools, support and respect to enable them to do this.

Welcoming, safe and well thought out settings.

Open-ended referrals. A limited set of sessions was seen as detrimental and left families coping with fall out.

More cognizance of the impact on families of well-documented behaviours such as violence and anti-social behaviour.

‘Don’t presume my child is telling the truth and I am not’.

INTERVENTIONS

Trauma and attachment aware.

Family and relationship based, focused on understanding the roots of behaviours and building attachments.

Non-blaming and empathic.

Most favoured therapies – DDP, therapeutic parenting, arts, play and narrative based therapies and equine therapy (particularly for self-regulation and relationship building).

Many popular providers, most notably Family Futures, Catchpoint, Integrate Families, Chrysalis and many ex-CAMHS independent providers.

REGIONAL CENTRES OF EXPERTISE?

Families broadly in favour – as a focus for the development of expertise.

Team approach including social care, education, health, police.

It could take responsibility for transition in and out of tier 4 services, which is seen as missing.

Include parents and carers in governance.

Existing CAMHS models are popular, some are no longer in existence (two Clinical Psychologists each reported they had run award-winning services for looked after and adopted children and both had had funding withdrawn, both services had subsequently closed).

Prepared by Sally Donovan, 20 October 2015, with thanks to everyone who provided feedback.

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6 thoughts on “CAMHS Roundtable – The Dog Shit in the Room”

Splendid assessment Sally. Put simply too many CAMHS workers see adopters as part of the problem, not part of the solution, because they fail to grasp the legacy of maltreatment and neglect.
Sadly unless they receive a massive amount of retraining and fresh neuroscience linked knowledge the situation is unlikely to improve.
Adopters often present as stressed out, angry, despairing adults …. CAMHS fail to realise we didn’t start like that, it’s the effect of living with grotesque behaviours from our kids and inadequate support.
Keep up the good fight Sally. You are doing a grand job. Many many thanks to you and the team.